{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T08:36:27Z","timestamp":1775032587853,"version":"3.50.1"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000},"content-version":"vor","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01 AI114320"],"award-info":[{"award-number":["R01 AI114320"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["T32 AI070114"],"award-info":[{"award-number":["T32 AI070114"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01 DK108424"],"award-info":[{"award-number":["R01 DK108424"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43 TW010060"],"award-info":[{"award-number":["D43 TW010060"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. Intern. AIDS Soc."],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>HIV diagnosis is the necessary first step towards HIV care initiation, yet many persons living with HIV (PLWH) remain undiagnosed. Employing multiple HIV testing strategies in tandem could increase HIV detection and promote linkage to care. We aimed to assess an intervention to improve HIV detection within socio\u2010sexual networks of PLWH in two sexually transmitted infections (STI) clinics in Lilongwe, Malawi.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a randomized controlled trial to evaluate an intervention combining acute HIV infection (AHI) screening, contract partner notification and social contact referral versus the Malawian standard of care: serial rapid serological HIV tests and passive partner referral. Enrolment occurred between 2015 and 2019. HIV\u2010seropositive persons (two positive rapid tests) were randomized to the trial arms and HIV\u2010seronegative (one negative rapid test) and \u2010serodiscordant (one positive test followed by a negative confirmatory test) persons were screened for AHI with HIV RNA testing. Those found to have AHI were offered enrolment into the intervention arm. Our primary outcome of interest was the number of new HIV diagnoses made per index participant within participants\u2019 sexual and social networks. We also calculated total persons, sexual partners and PLWH (including those previously diagnosed) referred per index participant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1230 HIV\u2010seropositive persons were randomized to the control arm, and 561 to the intervention arm. Another 12,713 HIV\u2010seronegative or \u2010serodiscordant persons underwent AHI screening, resulting in 136 AHI cases, of whom 94 enrolled into the intervention arm. The intervention increased the number of new HIV diagnoses made per index participant versus the control (ratio: 1.9; 95% confidence interval (CI): 1.2 to 3.1). The intervention also increased the numbers of persons (ratio: 2.5; 95% CI: 2.0 to 3.2), sexual partners (ratio: 1.7; 95% CI: 1.4 to 2.0) and PLWH (ratio: 2.3; 95% CI: 1.7 to 3.2) referred per index participant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Combining three distinct HIV testing and referral strategies increased the detection of previously undiagnosed HIV infections within the socio\u2010sexual networks of PLWH seeking STI care. Combination HIV detection strategies that leverage AHI screening and socio\u2010sexual contact networks offer a novel and efficacious approach to increasing HIV status awareness.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25701","type":"journal-article","created":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T10:08:15Z","timestamp":1619777295000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["A randomized controlled trial evaluating combination detection of HIV in Malawian sexually transmitted infections clinics"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7648-0651","authenticated-orcid":false,"given":"Jane S","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitch","family":"Matoga","sequence":"additional","affiliation":[{"name":"UNC Project Malawi Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian W","family":"Pence","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly A","family":"Powers","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Courtney N","family":"Maierhofer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Jere","sequence":"additional","affiliation":[{"name":"UNC Project Malawi Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia","family":"Massa","sequence":"additional","affiliation":[{"name":"UNC Project Malawi Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiraz","family":"Khan","sequence":"additional","affiliation":[{"name":"UNC Project Malawi Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah E","family":"Rutstein","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Infectious Diseases University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sam","family":"Phiri","sequence":"additional","affiliation":[{"name":"Lighthouse Trust Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2174-313X","authenticated-orcid":false,"given":"Mina C","family":"Hosseinipour","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Infectious Diseases University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5917-9664","authenticated-orcid":false,"given":"Myron S","family":"Cohen","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Infectious Diseases University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irving F","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Institute for Global Health and Infectious Diseases University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1934-7827","authenticated-orcid":false,"given":"William C","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC USA"},{"name":"Division of Epidemiology College of Public Health The Ohio State University Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2389-6973","authenticated-orcid":false,"given":"Kathryn E","family":"Lancaster","sequence":"additional","affiliation":[{"name":"Division of Epidemiology College of Public Health The Ohio State University Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,4,30]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS).90\u201090\u201090 An ambitious treatment target to help end the AIDS epidemic.Geneva;2014[cited 2020 Mar 10]. Available from:https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/90\u201090\u201090_en.pdf"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105243"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283324283"},{"key":"e_1_2_10_5_1","unstructured":"World Health Organization.Consolidated guidelines on HIV testing services: 5cs: consent confidentiality counselling correct results and connection 2015.Geneva:World Health Organization.2015[cited 2020 Jun 19]. Available from:https:\/\/apps.who.int\/iris\/handle\/10665\/179870"},{"key":"e_1_2_10_6_1","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS). Fact Sheet \u2010 World AIDS Day. 2020 [cited 2021 Feb 11]. Available from: https:\/\/www.unaids.org\/en\/resources\/fact\u2010sheet."},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0b013e32833a0d3a"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000853"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200402200-00019"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001555"},{"key":"e_1_2_10_11_1","unstructured":"World Health Organization. Guidelines on HIV Self\u2010Testing and Partner Notification. Geneva; 2016 [cited 2020 Mar 10]. Available from: https:\/\/www.who.int\/hiv\/pub\/self\u2010testing\/hiv\u2010self\u2010testing\u2010guidelines\/en\/."},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000066"},{"key":"e_1_2_10_13_1","unstructured":"UNAIDS.AIDSinfo Country Factsheets \u2010 Malawi 2019.Geneva Switzerland;2019[cited 2020 Mar 10]. Available from:http:\/\/aidsinfo.unaids.org\/"},{"key":"e_1_2_10_14_1","unstructured":"2016 Malawi HIV Testing Services Guidelines.Lilongwe:Ministry of Health;2016."},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.2002.02164.x"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280215588569"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60842-8"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0000000000000121"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000060"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e318202bf7d"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(16)30214-4"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000529"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000032"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25310"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0183944"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25308"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25315"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25307"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2016.0151"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czs140"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1108524"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1086\/512371"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25701","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.25701","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25701","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T20:26:19Z","timestamp":1693599979000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.25701"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":31,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1002\/jia2.25701"],"URL":"https:\/\/doi.org\/10.1002\/jia2.25701","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4]]},"assertion":[{"value":"2020-08-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-30","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e25701"}}